Other specialists, however, believe the guidelines will improve screening and raise awareness among women of the potential risks of screening.

An invitation from MedPage Today for specialists in mammography -- in radiology and in other disciplines -- to comment on the new guidelines produced the same sharp division which has characterized the mammography debate for decades.

"We will sadly see a reduction in the 30% mortality decrease in breast cancer. We will take a step backwards instead of forward in our goal to diagnose early curable breast cancer, " said Rachel F. Brem, MD, FACR, FSBI, director of breast imaging at George Washington University.

Echoing Brem's view was Murray Rebner, MD, FACR, FSBI, immediate past president of the Society of Breast Imaging and director of breast imaging at Beaumont Hospitals in Royal Oak, Mich. He said that "if adopted, these scientifically and methodically flawed guidelines might inhibit and reduce access to annual screening mammography and will result in thousands of unnecessary deaths from breast cancer."

And the recommendations were broadly attacked by Jay A. Baker, MD, FSBI, chief of breast imaging at Duke University Medical Center. "The USPSTF underestimates the undeniable life-saving benefits of screening mammography and overestimates the potential risks," he said.

Avice O'Connell, MD, FACR, FSBI, director of women's imaging at the University of Rochester Medical Center, said, "Many women will not get annual mammograms and so if they do get breast cancer, it will likely present as a lump in the breast and probably will be larger than the mammogram would detect."

One senior breast oncologist warned of a disproportionate racial impact. Lisa A. Newman, MD, MPH, FACS, FASCO, of Henry Ford Health System in Detroit, said the recommendations will have "the unintended consequence of widening the breast cancer mortality disparity that already exists between African American and white American women, because of the facts that African American women are more likely to be diagnosed with breast cancer at younger ages, and are more likely to be diagnosed with aggressive forms of the disease such as triple negative breast cancer."

Do the Recommendations Matter?

Adam Cifu, MD, FACP, professor of medicine at the University of Chicago, said he expected the recommendations to have an impact. "I think these guidelines may subtly affect physician behavior. The persistence of the biennial recommendation has begun to enter the consciousness of physicians and patient," he said.

Joy Melnikow, MD, MPH, director of the Center for Healthcare Policy and Research at the University of California Davis, said the guidelines "will build the growing awareness among clinicians and patients that breast cancer screening has both benefits and harms." Melnikow said they will also " inform decision making for women aged 40-49 about screening and promote discussion about false positive results and overdiagnosis."

Other specialists said they did not plan any changes because of the recommendations.

"Our practice performance metrics outperform national standards which is the main reason we follow beginning at age 40 annually," said Susan C. Harvey, MD, director of breast imaging at the Johns Hopkins Medical Institutions.

Similarly, said Wendie Berg, MD, PhD, FACR, a radiologist at Magee-Womens Hospital at the University of Pittsburgh Medical Center, "We will continue to recommend annual screening mammography beginning at age 40, and especially by age 45."

And, said Larry Norton, MD, deputy physician-in-chief for breast cancer programs at Memorial Sloan Kettering Cancer Center, "These recommendations will not influence my practice or my own recommendations to the public. As the ACS and the USPSTF say: annual mammographic screening reduces breast cancer mortality in all age groups 40 and over."

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